Commentary: Climate change worry among adolescents—on the importance of going beyond the constructive–unconstructive dichotomy to explore coping efforts—a commentary on Sciberras and Fernando (2021)

This opinion piece comments on Sciberras and Fernando’s (2021) article in which an 8-year longitudinal study is presented. The authors investigate trajectories of climate change worry through adolescence and associations with measures of depression and engagement with news and politics in late adolescence. Their objective is to explore whether climate change worry is a constructive or unconstructive psychological phenomenon. Their conclusion is that it is mainly an adaptive response but, for some groups, such as young people with pre-existing mental health problems, climate change worry could exacerbate their difficulties. In this commentary, it is argued that since research has found diverse results regarding whether climate worry is adaptive or not, one should perhaps not focus so much on the emotion itself, but rather on how people cope with their worry. Some examples of how young people cope with climate change are presented, and it is argued that taking account of these coping strategies in future longitudinal studies would be beneficial.     

中青年直肠癌造口患者心理痛苦现状及影响因素分析

目的探讨中青年结直肠癌造口患者心理痛苦现状,分析影响因素,为临床护理干预提供依据。方法选取2018年6月—2019年5月医院收治的146例中青年结直肠癌造口患者,采用患者的一般资料问卷、心理痛苦筛查工具的心理痛苦温度计(DT)和问题列表(PL)进行问卷调查。结果中青年结直肠癌造口患者心理痛苦评分为(5.78±2.65)分,心理痛苦检出率为63.70%(DT评分≥4分),PL得分频率前十位的条目分别是体形/外表、身体活动受限、经济问题、工作/上学、担忧、性、洗澡/更换衣物、与伴侣相处、疼痛、对日常活动丧失兴趣。Logistic回归分析得出疼痛情况、造口自护能力、婚姻3个自变量对DT得分≥4分有统计学意义。结论中青年结直肠癌造口患者心理痛苦发生率高,且疼痛情况、造口自护能力、婚姻是心理痛苦的独立影响因素。在临床工作中应重点关注该类人群,同时应积极控制疼痛,加强健康教育,关注其家庭婚姻状况。     

Very fast-progressive pulmonary opacities and high inflammatory factors levels are associated with decease of young Coronavirus Disease 2019 patients

We aimed to retrospectively analyze the clinical and computed tomography (CT) characteristics of young adults with Coronavirus Disease 2019 (COVID-19) pneumonia who were critically ill and to identify the features associated with non-survival.Thirty-eight COVID-19 patients (20–45 years old, 28 men) who had been admitted in the intensive care unit were included, including 18 non-survivors (group 1) and 20 survivors (group 2). Their clinical characteristics and initial and follow-up CT were compared between groups.In group 1, the days from illness onset to death were 21.1 ± 10.3 days; 7 patients had underlying comorbidities. At admission, group 1 exhibited higher serum ferritin and interleukin-6 (IL-6) levels (1142.6 ± 242.4 mg/L and 33.8 ± 18.6 mmol/L) compared with group 2 (728.3 ± 150.9 mg/L and 15.2 ± 6.9 mmol/L, P < .01). Group 1 exhibited more rapidly progressive opacities and consolidation in follow-up CT (16.7 ± 3.1 scores, 15.7 ± 3.1 segments) than group 2 (11.4 ± 4.0 scores, 10.3 ± 4.6 segments, P < .01). The oxygenation index was lower (87.6 ± 19.2 vs 99.1 ± 20.4 mm Hg) and the mechanical ventilation duration was longer (14.7 ± 6.9 vs 9.7 ± 3.7 days) in group 1 compare with group 2 (P < .01).Compared with the survivors, the non-survivors showed higher serum ferritin and IL-6 levels, more rapidly progressive opacities in CT, lower oxygenation index, and longer mechanical ventilation durations. Special attention to ferritin/IL-6 levels and oxygenation index as well as early CT application and timely reexaminations are important to identify the individuals who may be at risk of becoming critically ill.     

预测年轻乳腺癌患者生存率列线图的建立和验证

目的:构建预测年轻乳腺癌患者生存情况的列线图，以期帮助临床诊疗。方法:收集SEER数据库中5 525例年轻乳腺癌患者的临床信息，通过单因素Log-rank检验和多因素Cox生存分析筛选出独立预后因素,用于构建预测患者3、5年总生存率(overall survival,OS)和癌症特异性生存率（cancer special survival,CSS)的列线图，将我院就诊的147例年轻乳腺癌患者作为验证集进行外部验证。结果:单因素和多因素分析结果显示，种族、病理类型、组织学分级、T分期、N分期、M分期、ER状态、HER-2状态、手术方式是与患者OS和CSS相关的独立危险因素，将这些因素纳入并建立预测患者OS和CSS的列线图模型。内部和外部验证结果显示模型具有良好的预测性能。基于建立的OS和CSS列线图模型对患者进行了风险分层，能够准确地将年轻乳腺癌患者分成预后有显著差异的三个风险亚组。结论:本研究构建的预测模型能较为准确的预测年轻乳腺癌患者的预后情况，为临床的诊疗提供科学依据。     

腹部超声联合阴道灌注0.9%氯化钠诊断幼女阴道异物的临床价值

目的 分析腹部超声联合阴道灌注0.9%氯化钠对幼女阴道异物的诊断价值。方法 回顾性分析2018年1月—2021年12月就诊于赣州市妇幼保健院妇科的102例疑似阴道异物幼女临床资料。患儿均接受经腹部超声、阴道灌注0.9%氯化钠检查。以宫腔镜诊治结果作为金标准，分析经腹部超声单独检测或腹部超声联合阴道灌注0.9%氯化钠诊断阴道异物的准确性、有效性。结果 宫腔镜结果显示，患儿中阴道炎有21例（20.59%），阴道异物有81例（79.42%），其中棉絮状物、谷物、头发丝等线状物最为常见；单独诊断、联合诊断出阴道异物分别有69例和79例，与宫腔镜诊断结果的K值分别为0.689和0.897。将宫腔镜诊断结果作为金标准，单独诊断、联合诊断阴道异物的敏感性分别为0.765（95% CI：0.594，0.816）、0.951（95% CI：0.826，0.995），特异性分别为0.667（95% CI：0.563，0.786）、0.905（95% CI：0.795，0.972），准确度分别为0.745（95% CI：0.586，0.813）、0.941（95% CI：0.817，0.984），单独诊断、联合诊断的敏感性、特异性、准确度可信区间无重叠，说明有统计学意义。结论 阴道灌注0.9%氯化钠可增强幼女阴道异物在超声下的显影，提升诊断准确性、有效性，且操作简单、损伤小，起到清洁阴道作用。     

提高医用化学理论大课质量的教学实践和探索

理论大课能直接反映教师的教学水平和学生的学习质量。为了提高医学院校医用基础化学大课的教学质量，教师采取一系列措施和方法，从备课、上课、课后答疑、辅导、考试等各个环节入手，进行教学实践和探索，以期学生的成绩和能力有明显提高，经过多年的实践和探索，收到了良好的效果，达到了教学目的。